The Implications of HIV Biomedical Prevention for Perceived HIV Risk and Psychosexual Health among Sexual Minority Men in the United States

Sexual minority men (SMM) represent more than 50% of individuals living with HIV in the USA despite making up less than 5% of the general population. The advent of biomedical HIV prevention interventions has far-reaching benefits for SMM, potentially enhancing psychosexual health. We examined the relationship of pre-exposure prophylaxis (PrEP) use and Undetectable = Untransmittable (U = U) belief to psychosexual health among HIV-negative/status-unknown SMM. Participants (n = 351) were recruited via hookup apps and social media to participate in an online survey study in 2019-2020. Participants completed measures of PrEP use and U = U belief (the predictors), perceived HIV risk (the mediator), and psychosexual health (sexual anxiety, sexual esteem, and sexual satisfaction; the outcomes). The effects of predictors and their interaction were tested. Most participants were cisgender (99.70%) and White (71.22%). PrEP and U = U belief were positively correlated with each other and both were negatively correlated with perceived HIV risk. SMM who used PrEP reported more sexual esteem and satisfaction compared with SMM who did not. Indirect paths from use of PrEP (vs. non-use) through perception of lower HIV risk were significant relative to all three outcomes. U = U belief and the interaction of U = U belief and PrEP use were not significant direct or indirect predictors of psychosexual health. The findings suggest that it may be beneficial for public health messaging and healthcare settings to highlight the psychosexual benefits of using PrEP.